Intracranial complications before and after endoscopic skull base reconstruction.
BACKGROUND
Endoscopic skull base reconstruction (ESBR) has been widely accepted in the management of cerebrospinal fluid (CSF) leaks. However, it is not the CSF leak itself but the potential for life-threatening intracranial complications (ICCs) that is of primary clinical concern. The risk of developing complications, such as meningitis, in a skull base defect is unknown. Many ESBR are multilayered soft tissue repairs, and long-term prevention of ICCs is not well described.


METHODS
Retrospective chart review and telephone consultation was used to assess patients who had an ESBR from 2002 to 2008. The incidence of an ICCs (meningitis, cerebral abscess, and pneumocephalus) and associated risk factors were assessed before and after surgery.


RESULTS
One hundred six patients underwent ESBR (mean age (+/-SD), 47.7 +/- 18.5 years; range, 2-78 years) with 95.3% long-term follow-up (mean, 19.9 +/- 16.3 months). ICCs occurred in 21.7% of patients at presentation, in 2.8% of patients during the perioperative period (<2 weeks), and in one patient (0.9%) during the postoperative period. Risk factors for presenting with an ICC and meningitis were revision cases performed elsewhere (chi(2) = 9.10; p = 0.007) and leaking encephaloceles (chi(2) = 5.98; p = 0.014). Factors not associated with increased ICC were an active CSF leak at presentation (chi(2) = 3.03; p = 0.082) and previous radiotherapy.


CONCLUSIONS
ESBR offers an excellent long-term option in preventing subsequent ICC with low perioperative complications. ESBR is robust with delayed (>2weeks) CSF leakage occurring in only 1.9% regardless of etiology. The presence of identifiable risk factors for ICC may guide the surgeon in determining the urgency of ESBR.
Harvey
Richard J
RJ
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA. richard@richardharvey.com.au
Smith
Jacob E
JE
Wise
Sarah K
SK
Patel
Sunil J
SJ
Frankel
Bruce M
BM
Schlosser
Rodney J
RJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008581:Meningitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011007:Pneumocephalus / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed